Introduction
This topic covers inflammation of the mucosa of the mouth (stomatitis), of the tongue (glossitis) and of the tonsils and pharyngeal lymphoid ring (angina, i.e. tonsillitis), with special attention to the complications of streptococcal infection, both local-purulent and late immune-mediated.
Stomatitis
Stomatitis is inflammation of the oral mucosa. It may be primary (local infection, trauma, irritants) or part of a general disease (vitamin deficiency, blood disease, immunodeficiency, diabetes, uraemia, infectious fevers). Morphological forms are named by the type of exudate and tissue damage.
- Catarrhal: the commonest form. The mucosa is red, swollen and covered with mucus, with desquamated epithelium and leukocytes. It heals completely once the cause is removed.
- Fibrinous (pseudomembranous): a grey-white fibrin film; seen in diphtheria and after chemical or thermal injury.
- Erosive and ulcerative: epithelial loss, then deeper ulcers with a fibrinopurulent floor. Examples are aphthous stomatitis (small, round, painful, shallow ulcers with a red halo and a yellow-grey base, recurrent), and ulcero-membranous (Vincent) stomatitis caused by fusiform bacteria with spirochaetes, favoured by poor hygiene and weakened resistance.
- Viral: herpetic stomatitis (HSV-1) with vesicles that rupture to erosions; epithelial cells show multinucleation and intranuclear inclusions.
- Fungal (candidiasis, thrush): Candida albicans forms white, removable plaques on a red base. It occurs in infants, in diabetics, after antibiotics or corticosteroids, and in immunodeficiency. Microscopy shows yeasts and pseudohyphae in the superficial epithelium.
- Gangrenous (noma, cancrum oris): rapidly spreading moist necrosis of the cheek in severely malnourished or immunosuppressed children; it destroys soft tissue and bone.
- Specific stomatitis occurs in tuberculosis, syphilis (primary chancre, mucous patches, gumma) and some other infections.